犬常見腫瘤臨床治療

ClinicalManagementofCommonCanineTumors

犬常見腫瘤的臨床治療G.NealMauldin,DVMDACVIM(InternalMedicineandOncology)DACVR(RadiationOncology)LymphoproliferativeDiseases

淋巴細(xì)胞增生性疾病Lymphoma淋巴瘤B-cell,T-cellMultipleMyeloma多發(fā)性骨髓瘤B-cellPlasmacytoma漿細(xì)胞瘤skeletal,extra-skeletal骨骼的，骨骼外的Leukemia白血病acutelymphoblastic急性淋巴細(xì)胞白血病chroniclymphocytic慢性淋巴細(xì)胞白血病CanineLymphoma犬淋巴瘤

commonlydiagnosedmalignancyindogs在犬通常診斷為惡性incidence24/100,000發(fā)病率24/100,000etiologyunknown機(jī)理不明geneticpredisposition遺傳素質(zhì)BullMastiff,GoldenRetriever馬士提夫犬，金色尋回獵犬environmentaltoxins周圍環(huán)境中的毒素2,4-DRetrovirus反轉(zhuǎn)錄病毒CanineLymphoma犬淋巴瘤

ClinicalSigns臨床癥狀peripherallymphadenopathy周圍淋巴結(jié)病anorexiaandlethargy厭食、乏力weightloss體重減輕evidenceofhemorrhage有出血的表現(xiàn)dyspnea呼吸困難polyuriaandpolydipsia多尿、多飲vomitinganddiarrhea嘔吐、拉稀CanineLymphoma犬淋巴瘤

ClinicalEvaluation臨床評(píng)估physicalexaminationfindings臨床檢查所見peripherallymphadenopathy周圍淋巴結(jié)病splenomegalyand/orhepatomegaly脾腫大和/或肝腫大abdominalmass腹部腫塊pallor蒼白petechialorecchymotichemorrhage淤血點(diǎn)或淤血斑musclewasting肌肉萎縮pleuralorabdominaleffusion胸腔或腹腔積液“Typical”Presentation典型表現(xiàn)

CanineLymphoma犬淋巴瘤CanineLymphoma犬淋巴瘤

UnusualPresentations罕見癥狀CanineLymphoma犬淋巴瘤

ClinicalEvaluation臨床評(píng)估m(xù)endeddiagnostictesting建議進(jìn)行的檢查診斷completebloodcountandbiochemicalprofile全血計(jì)數(shù)和血液生化檢測(cè)Urinalysis尿液分析Knott’stestformicrofilaria那特氏檢測(cè)微絲蚴chestandabdominalradiographs胸部和腹部X光片Electrocardiogram心電圖bonemarrowaspirate骨髓穿刺tissuebiopsyforhistopathology活組織組織病理學(xué)檢查PulmonaryMass肺部塊狀陰影

CytologicDiagnosisofLSA

淋巴肉瘤細(xì)胞學(xué)檢查SanctuarySite

CanineLymphoma犬淋巴瘤CanineLymphoma犬淋巴瘤

ClinicalStaging臨床分期StageI-singlenodeinvolvement.一期-涉及單個(gè)淋巴結(jié)StageII-multiplenodeinvolvementononesideofdiaphragm.二期-涉及膈單側(cè)的多個(gè)淋巴結(jié)StageIII-generalizedlymphnodeinvolvement.三期-涉及全身淋巴結(jié)CanineLymphoma犬淋巴瘤

ClinicalStaging臨床分期StageIV-stagesIthroughIIIwithliverand/orspleeninvolvement.四期-一期至三期涉及到肝臟和或脾臟StageV-stagesIthroughIVwithbonemarrowinvolvement.五期–一期至四期，涉及到骨髓

substage(a)-nosignsofsystemicillness

亞期（a）-無全身病變癥狀

substage(b)-signsofsystemicillness

亞期（b）-出現(xiàn)全身病變癥狀SplenicLymphoma

脾淋巴瘤CanineLymphoma犬淋巴瘤

Prognosis預(yù)后multiplefactorsmayaffectprognosis多種因素都可能影響預(yù)后histologicgradeofmalignancy惡性腫瘤組織學(xué)分級(jí)substageofdisease疾病亞期Hypercalcemia低血鈣responsetotherapy對(duì)治療的反應(yīng)chemotherapyprotocol化療方案gender性別mediansurvivaltimesvarywithchemotherapyprotocolutilized平均生存期受化療方案應(yīng)用的影響Lymphoma&Hypercalcemia

淋巴瘤和高血鈣

Canbeassociatedwithanystage 可見于任何分期Manyhavemediastinalformorbonemarrowinvolvement

很多涉及到縱膈的形式或者骨髓

Rosenberg,1991n=37AMM

=43%BMinvolvement=41%41%涉及骨髓HypercalcemiaandLSA高血鈣和淋巴肉瘤

ThymicandBoneMarrow胸腺瘤和骨髓瘤Lymphoma&Hypercalcemia

淋巴瘤和高血鈣

Prognosticimportance預(yù)后的重要性negativeprognosticfactor負(fù)面預(yù)后因素

Rosenberg,1991n=37remissionduration(median)；平均緩解期overall-6months(25%>14months)全部-6個(gè)月(25%>14個(gè)月)AMM-3months;noAMM-8months

Weller,1982n=12survivaltime-significantlyshorter存活期-明顯縮短CanineLymphoma犬淋巴瘤

Chemotherapy化療CanineLymphoma犬淋巴瘤

Chemotherapy化療potentialtoxicitiesassociatedwithchemotherapyforlymphomaindogs化學(xué)療法治療犬淋巴瘤的潛在毒性myelosuppressionandinfectionorsepsis骨髓抑制和感染或敗血癥anorexiaandlethargy厭食、嗜睡nauseaandvomiting惡心、嘔吐diarrhea拉稀cardiotoxicity心臟毒性alopecia脫毛Lymphoproliferativedisorders

淋巴組織增殖性疾病DisordersofLymphoidorigincells淋巴樣組織細(xì)胞疾病MultipleMyeloma多發(fā)性骨髓瘤ChronicLymphocyticLeukemia慢性淋巴細(xì)胞白血病AcuteLymphoblasticLeukemia急性淋巴細(xì)胞白血病MultipleMyeloma多發(fā)性骨髓瘤Plasmacelltumor–systemic漿細(xì)胞腫瘤—全身性Diagnosticcriteria:診斷標(biāo)準(zhǔn)：Bonemarrowinfiltratewithneoplasticplasmacells骨髓內(nèi)腫瘤性血細(xì)胞浸潤BenceJonesProteinuriaBenceJones蛋白尿asubunitofimmunoglobulina-免疫球蛋白Monoclonalgammopathy單克隆免疫球蛋白病Lyticbonelesions骨溶解MultipleMyeloma

多發(fā)性骨髓瘤MultipleMyeloma

多發(fā)性骨髓瘤

Criteria(2outof4)標(biāo)準(zhǔn)（4種中至少2種）IgGorIgAmonoclonalgammopathyIgG或IgA單克隆免疫球蛋白病radiographicevidenceofosteolyticbonelesionsX線片檢查顯示骨溶解>10%neoplasticplasmacellsinBM

骨髓中有>10%腫瘤化的血細(xì)胞

BenceJonesproteinuriaBenceJones蛋白尿MonoclonalGammopathy

單克隆免疫球蛋白病Multiplemyeloma多發(fā)性骨髓瘤Waldenstrom’s

MacroglobulinemiaWaldenstrom氏巨球蛋白血癥Lymphoma淋巴瘤CLL慢性淋巴細(xì)胞白血病Plasmacellleukemia

血漿細(xì)胞白血病Extramedullaryplasmacytoma漿細(xì)胞瘤

Ehrlichia埃里希體FIPAmyloidosis淀粉樣變性O(shè)ccultheartworm

disease潛在心絲蟲疾病Plasmacyticenterocolitis漿細(xì)胞性結(jié)腸炎Leishmaniasis利什曼病MultipleMyeloma–Treatment

多發(fā)性骨髓瘤-治療Chemotherapy化療day1-10 Melphalan0.1mg/kgPOq24h

1-10天美法侖0.1mg/kg口服24h一次day>11 Melphalan0.05mg/kgPOq24h

11天之后美法侖0.05mg/kg口服24h一次day1-10 Pred15mg/m2POq24h

1-10天潑尼松15mg/m2

口服24h一次day11-60 Pred15mg/m2POq48h

11-60天潑尼松15mg/m2

口服48h一次MultipleMyeloma–Treatment

多發(fā)性骨髓瘤-治療Radiationtherapy放射療法localizeddisease局部病變spinalcordcompression

脊髓壓迫癥neurologicdisease

神經(jīng)系統(tǒng)疾病MultipleMyeloma–Prognosis

多發(fā)性骨髓瘤–預(yù)后Survival-18months(median)存活期–18個(gè)月(平均)Negativeprognosticfactors負(fù)面預(yù)后因素hypercalcemia高血鈣BenceJonesproteinuriaBenceJones蛋白尿extensiveskeletallesions廣泛性骨骼損傷renalinsufficiency腎功能不足HyperviscositySyndrome

高粘稠度綜合征Majorcomplicationofmonoclonalgammopathy

單克隆免疫球蛋白病的主要并發(fā)癥dogs: 20%withmonoclonalgammopathyhaveHVS犬：20%單克隆免疫球蛋白病患犬患有高粘稠度綜合征Markedincreaseinserumviscosity血漿粘稠度明顯增加OstwaldviscosimeterOstwald粘度計(jì)expressedrelativetowater相對(duì)于水normal<1.8seconds(dog)正常＜1.8秒HyperviscositySyndrome

高粘稠度綜合征Mechanisms:機(jī)制protein-proteininteractions蛋白質(zhì)相互作用IgM-largemolecule(MW=900,000)IgM–大分子（分子量=900，000）IgAorIgG-lesslikelytocauseHVSIgA或IgG–很少引起高粘稠度綜合征HyperviscositySyndrome高粘稠度綜合征-

ClinicalSigns臨床癥狀Coagulopathies凝血病ecchymoses,petechia,epistaxis瘀血斑，淤血點(diǎn)，鼻衄melena,retinalhemorrhage黑糞，視網(wǎng)膜出血mechanisms:機(jī)制plateletdysfunction血小板功能不良paraproteinsactascoagulationfactor

inhibitorsandbindfactors(V,VII,VIII)

副蛋白類充當(dāng)凝血因子抑制和束縛因子(V,VII,VIII)BleedingDiatheses

出血素質(zhì)HyperviscositySyndrome高粘稠度綜征

ClinicalSigns臨床癥狀Neurologicdysfunction神經(jīng)系統(tǒng)功能異常cerebralchanges大腦的變化dementia,depression,coma癡呆，抑郁，昏迷mechanisms:機(jī)制increasedbloodviscosity血液粘度增加hypovolemia,poorperfusion低血容量，低灌注量HyperviscositySyndrome高粘稠度綜合征-

ClinicalSigns臨床癥狀Ocularabnormalities眼睛的異常情況retinalhemorrhage/detachment視網(wǎng)膜出血/脫落vesseldilation&tortuosity血管擴(kuò)張和扭曲papilledema視乳頭水腫blindness失明HyperviscositySyndrome高粘稠度綜合征-

ClinicalSigns臨床癥狀Congestiveheartfailure先天性心衰mechanism:機(jī)制increasedoncoticpressureduetoparaproteins

由副蛋白類引起的腫脹性壓迫HyperviscositySyndrome高粘稠度綜合征-

Treatment治療Treatunderlyingcause治療潛在疾病monoclonalgammopathy單克隆免疫球蛋白病Reduceserumviscosity降低血清粘稠度plasmapheresis血漿去除術(shù)phlebotomy靜脈切開術(shù)withdraw20ml/kg撤除20ml/kgreplacewithcrystalloids30ml/kg取晶體液代替30ml/kgfollowPCV/TS接著檢測(cè)PCV/TSChronicLymphocyticLeukemia

慢性淋巴細(xì)胞白血病DiseaseofOlderAnimals老年動(dòng)物疾病Femalesoverrepresented雌性犬表現(xiàn)過多Bonemarrowinfiltrateofmature-appearinglymphocytes骨髓內(nèi)有成熟淋巴樣細(xì)胞浸潤Lymphocytosiscommon常見淋巴細(xì)胞增多Mortalityduetoinfection死亡率決定于感染情況AcuteLymphoblasticLeukemia

急性淋巴細(xì)胞白血病Bonemarrowinfiltratewithimmaturelymphoblasts骨髓內(nèi)大量未成熟的淋巴母細(xì)胞浸潤lymphocytosisvariable淋巴細(xì)胞增多反復(fù)不定Anemia,Thrombocytopenia貧血，血小板減少Youngdogs幼年動(dòng)物L(fēng)abRetrievers?拉布拉多犬Mortalityduetoinfection,anemia你死亡率由感染和貧血決定Prologue:MammaryTumorsinCompanionAnimals前言：伴侶動(dòng)物的乳腺腫瘤

Mammarytumorsareextremelycommontumorsinbothdogsandcats.Theyarealsosomeofthemostpoorlymanagedtumorsinveterinarymedicine.Appropriateearlytherapyisoftencurative.Inappropriateearlytherapyoftenresultsinthedeathofthepatientduetomammarycancer.乳腺腫瘤在犬貓中非常常見。同時(shí)，它也是獸醫(yī)治療中效果最差的腫瘤之一。早期恰當(dāng)?shù)闹委熗ǔＤ軌蛑斡?。早期不恰?dāng)?shù)闹委熗ǔ５趧?dòng)物由于乳腺癌而死亡。MammaryTumorsofDogs 犬乳腺腫瘤Mostcommontumor,exceptskin除皮膚外最常見的腫瘤Accountfor42%ofalltumorsinbitches占所有母犬腫瘤的42%1:1malignant:benign惡性：良性為1：1Extremelyheterogeneousdiseaseinthedog,histologydifficult該疾病在犬中有非常多的種類，組織學(xué)檢查困難Histologyaloneoflittlehelpinformulatingaprognosis單獨(dú)進(jìn)行組織學(xué)檢查幾乎不能判斷預(yù)后HistologicTypes:CanineMammary

Cancer組織學(xué)分型：犬乳腺癌Mostcommonlyepithlial上皮型最常見adenomas腺瘤adenocarcinomas腺癌squamouscellcarcinoma鱗狀細(xì)胞癌Mesenchymal(as)mon間質(zhì)型（肉瘤）不常見Miscellaneousalsoreported也有混合型的報(bào)道m(xù)astcelltumors肥大細(xì)胞瘤lymphoma淋巴瘤Mixedhistogenesis混合組織發(fā)生EpithelialTumors:CanineMammaryGland上皮腫瘤：犬乳腺1:1adenomas:adenocarcinomas腺瘤：腺癌為1：1Arisefrommanyanatomicsites,includingtheacinusandductules起源于很多解剖結(jié)構(gòu)，包括腺泡和腺管Histopathologyextremelycomplex組織病理學(xué)非常復(fù)雜anindividualpatientmayhavemultipletumors 單一病例可能有多種類型腫瘤50%chanceofmalignancyforeach

50%為惡性anindividualtumormayexhibitbothmalignantandbenigncharacteristics單一的腫瘤也可能同時(shí)存在良性和惡性的特征BiologicBehavior,CanineEpithelialTumors生物學(xué)行為，犬上皮腫瘤Adenomascuredwithsurgery腺瘤可以通過手術(shù)治愈Adenocarcinomastendtoexhibit:腺癌可能呈現(xiàn)：aggressivelocalbehavior局部侵略行為lymphaticmetastases,butalsolung,other淋巴轉(zhuǎn)移，肺轉(zhuǎn)移，其它，lymphaticobstruction,edema淋巴管阻塞，水腫Inflammatorycarcinomas炎性瘤highlymalignant高度惡性pro-coagulant;DICcommon 促凝血；常見于DICPrognosticFactors:CanineMammaryTumors預(yù)后因素：犬乳腺腫瘤Allshouldbeapproachedasifmalignant所有的腫瘤都應(yīng)當(dāng)以惡性腫瘤來進(jìn)行評(píng)估Histologyaffectsrateofmalignancy組織學(xué)類別影響惡性的比率as>anaplasticcarcinomas>complex(differentiated)carcinomas肉瘤＞退行性癌＞混合（分化型）癌Specifichistologicdiagnosis(ieductularcarcinomavsacinaradenocarcinoma)isnotofprognosticsignificance特殊組織學(xué)診斷（例如腺管癌對(duì)腺泡腺癌）沒有顯著的預(yù)后意義PrognosticFactors:CanineMammaryTumors預(yù)后因素：犬乳腺腫瘤Growthcharacteristics生長特性expansionvsinvasion擴(kuò)張對(duì)浸潤Moreaggressivesurgeryrequiredforinvasivetumors對(duì)于浸潤瘤，手術(shù)時(shí)應(yīng)當(dāng)更加深入lymphatic/vascularinvasion淋巴/血管浸潤presenceincreasesmetastaticpotential表現(xiàn)出更多的轉(zhuǎn)移傾向Estrogenreceptorstatus雌激素受體情況ER+tumorsaremorewelldifferentiated雌激素受體+腫瘤分化良好EarlyOHEaffectsincidence早期絕育影響發(fā)病率PrognosticFactors:CanineMammaryTumors預(yù)后因素：犬乳腺腫瘤Stageofdiseaseimportant疾病的分期非常重要Factorswarrantingaworseprognosis:證明較差預(yù)后的因素large,poorlydefinedtumors大的，分界不明顯的腫瘤skininvolvement牽涉皮膚lymphatic/distantmetastasis淋巴/遠(yuǎn)距離轉(zhuǎn)移histologicgrading組織學(xué)分級(jí)simplevscomplex單一或混合difficulttodo,noconsistentresultsreported分級(jí)困難，報(bào)道的結(jié)果不統(tǒng)一Treatment:CanineMammaryTumors

治療：犬乳腺腫瘤Surgery!!手術(shù)treatallasifmalignant所有的惡性腫瘤removeandbiopsyalltumorspresent去除所有可見的腫瘤并且進(jìn)行活組織檢查submitentirespecimen將整個(gè)樣品送檢Mammarylymphaticdrainage:乳腺淋巴管glands1&2;axillarylymphnode

第1和2對(duì)乳腺腋窩淋巴結(jié)glands4&5,inguinallymphnode

第4和5對(duì)乳腺腹股溝淋巴結(jié)gland3?????第3對(duì)乳腺？？？？？Treatment:CanineMammaryTumors

治療：犬乳腺腫瘤Firstsurgeryisthebestsurgery首次手術(shù)是最佳的手術(shù)avoidsimplemastectomy,lumpectomy避免簡單的乳腺切除術(shù)，病灶切除術(shù)plansurgeryusingglandnumber計(jì)劃手術(shù)涉及的腺體數(shù)目radicalmastectomy??根治性乳房切除術(shù)bettertobetooaggressivethannotaggressiveenough過多切除比未徹底根除好Recurrenceorregrowth

復(fù)發(fā)或再生Definitelyneedsradicalsurgery肯定需要徹底的手術(shù)治療Treatment:CanineMammaryTumors

治療：犬乳腺腫瘤Completeresectionofmalignantdiseaseoften=cure惡性病變的徹底切除常常=治愈pleteresectionofmalignantdisease:75%deathfrommammarycancerwithin2years惡性病變的不完全切除：75%的病例在2年內(nèi)死于乳腺腫瘤Ifcompleteresectionisnotpossible,thenradiationtherapymaybeusedtoimprovelocalcontrol如果不能徹底切除，可以進(jìn)行放療進(jìn)行進(jìn)一步的局部控制KeyPoints:BreastCancerinCompanionAnimals要點(diǎn)：伴侶動(dòng)物的乳腺癌Complete

surgicalresectionbest最好進(jìn)行徹底的手術(shù)切除Earlyinterventionessential早期干預(yù)很必要Treatthemallasiftheyaremalignant如果是惡性腫瘤要全部處理Bettertotake1glandtoomanythan1toofew要認(rèn)為一個(gè)腺體很多而不是很少Givealltissuetothepathologist將所有的組織送病理師檢驗(yàn)Treatpossiblesystemicinvolvementaggressively徹底的處理可能涉及到的組織CanineMastCellTumors犬肥大細(xì)胞瘤

commontumorindogs犬常見腫瘤skinisthemostcommonsite皮膚是最常見位點(diǎn)11-27%ofmalignantskintumors11%-27%惡性皮膚腫瘤Boxer,BostonTerrier,Bulldog拳師犬，波士頓犭更犬，牛頭犬meanageof8.5years平均年齡8.5歲MastCells肥大細(xì)胞

Cytoplasmicgranulescontain:

細(xì)胞質(zhì)顆粒包含：Heparin肝素Histamine組織胺Eosinophilicchemotacticfactor嗜酸性趨化因子

蛋白水解酶ProteolyticenzymesCanineMastCellTumors–Site犬肥大細(xì)胞瘤-位點(diǎn)

Skin-mostcommonsite皮膚-最常見位點(diǎn)50%trunk,40%limbs50%軀干，40%四肢10%headandneck10%頭頸部Visceral-usuallymetastatic內(nèi)臟–通常為轉(zhuǎn)移性spleen,liver,kidney脾臟，肝臟，腎臟Otherprimarysites其它原發(fā)位點(diǎn)larynx,mediastinum,GItract,LN

喉部，縱膈，小腸，淋巴結(jié)CanineCutaneousMastCellTumor

犬表皮肥大細(xì)胞瘤

Dermal表皮1-10cm(usually<3cm)1-10厘米（通常小于3厘米）wellcircumscribed,raised,firm

與周圍組織分界清楚，隆起，堅(jiān)固+/-erythematousorulcerated+/-紅斑或潰瘍

Subcutaneous皮下soft,ill-definedmass柔軟，病變團(tuán)塊

canfeellikealipoma感覺像脂肪瘤normaloverlyingskin覆蓋的皮膚正常CanineMastCellTumors–Diagnosis

犬肥大細(xì)胞瘤–診斷Cytology細(xì)胞學(xué)priortosurgery手術(shù)前Histopathology組織病理學(xué)GradeI(well-differentiated)

一級(jí)（分化良好）GradeII(intermediate)

二級(jí)（中間型）GradeIII(poorlydifferentiated)

三級(jí)（分化不良）q

MastCellTumors-DiagnosticsandStaging

肥大細(xì)胞瘤–診斷和分期aspirationcytologyofskinmass皮膚腫塊的穿刺細(xì)胞學(xué)檢查biopsyofskinmass,histopathologicgrade皮膚腫塊的活組織檢查，組織病理學(xué)分級(jí)regionallymphnodeaspirationcytology,+/-biopsy局部淋巴結(jié)穿刺細(xì)胞學(xué)檢查，+/-活組織檢查abdominalradiographs腹部X片檢查abdominalultrasound腹部B超檢查MastCellTumors-DiagnosticsandStaging

肥大細(xì)胞瘤–診斷和分期

buffycoat棕黃色被毛bonemarrowaspirationcytology骨髓穿刺細(xì)胞學(xué)檢查thoracicradiographs胸片usuallynotindicated通常沒有指示性CBC,chemistrypanel,urinalysis全血計(jì)數(shù)，生化檢測(cè)，尿檢CanineMCT-WHOStaging

犬肥大細(xì)胞瘤–WHO分期

I-dermis,noLNinvolvement一期–表皮，沒有涉及淋巴結(jié)II-dermis,regionalLNinvolvement

二期–表皮，涉及局部淋巴結(jié)III-multipledermaltumorsorlargeinfiltratingtumorwithorwithoutregionalLNinvolvement

三期–復(fù)雜表皮腫瘤或大的浸潤性腫瘤，涉及或不涉及局部淋巴結(jié)IV-anytumorwithdistantmetastasisorrecurrencewithmetastasis

四期–任何轉(zhuǎn)移的腫瘤或復(fù)發(fā)轉(zhuǎn)移MastCellTumors–Complications

肥大細(xì)胞瘤–并發(fā)癥gastroduodenalulceration胃十二指腸潰瘍coagulationabnormalities凝血異常delayedwoundhealing傷口愈合延遲degranulation,hypotension,shock,death

細(xì)胞脫顆粒，低血壓，休克，死亡CanineMCT-GIulceration

犬肥大細(xì)胞瘤–胃腸道潰瘍

Histamine組胺StimulatesgastricH2receptors刺激胃H2受體increasesacidsecretion增加胃酸分泌gastrichypermotility胃運(yùn)動(dòng)功能亢進(jìn)Vesseldilation,increasedendothelialpermeability

血管擴(kuò)張，內(nèi)皮通透性增加intravascularthrombosis血管內(nèi)血栓ischemicnecrosis缺血性壞死CanineMastCellTumors–Heparin

犬肥大細(xì)胞瘤–肝素

lessthannormalmastcells少于正常肥大細(xì)胞localcoagulopathies局部凝血病thrombocytopenia血小板減少癥treatment治療protaminesulfate(antagonist)硫酸魚精蛋白（拮抗劑）CanineMCT-HypotensiveShock

犬肥大細(xì)胞瘤–低血壓性休克

resultsfromreleaseofhistamineandothervasoactiveagents由于組胺的釋放和其他活化血管因子tumormanipulation腫瘤控制cytotoxictherapy細(xì)胞毒性治療pretreatmentwithH1&H2antagonists

對(duì)H1和H2拮抗劑的預(yù)處理canresultindeath可以導(dǎo)致死亡CanineMastCellTumor–Treatment

犬肥大細(xì)胞瘤-治療Surgery手術(shù)RadiationTherapy放射療法Chemotherapy化學(xué)療法Other其他CanineMCT-SurvivalData

犬肥大細(xì)胞瘤–存活期

Surgery;n=83dogs手術(shù)；n=83只犬Patnaik(VetPath1984;21:469)%alive>1500days存活>1500天的%GradeI-93%(28/30)一級(jí)–93%(28/30)GradeII-47%(16/36)二級(jí)-47%(16/36)GradeIII-6%(1/17)三級(jí)-6%(1/17)CanineMCT–Treatment

犬肥大細(xì)胞瘤–治療SurgicalExcision手術(shù)切除IfpleteExcision若不完全切除Widerresection廣泛切除術(shù)Radiationtherapy放療Chemotherapy化療CombinationTherapy聯(lián)合治療CanineMCT–Chemotherapy

犬肥大細(xì)胞瘤–治療

Systemic全身性O(shè)ral口服Intravenous靜脈給藥Intralesional內(nèi)部損傷CanineMCT-AncillaryTherapy

犬肥大細(xì)胞瘤–輔助治療

H2antagonistsH2拮抗劑cimetidine西咪替丁ranitidine雷尼替丁H1antagonistsH1拮抗劑diphenhydramine苯海拉明CanineMCT–Chemotherapy

犬肥大細(xì)胞瘤–化療

Glucocorticoids糖皮質(zhì)激素Chlorambucil+Glucocorticoids

苯丁酸氮芥+糖皮質(zhì)激素Vinblastine+Cyclophosphamide+Glucocorticoids長春堿+環(huán)磷酰胺+糖皮質(zhì)激素L-asparaginaseL-天冬酰胺酶Other其他CanineMCT–Chemotherapy

犬肥大細(xì)胞瘤–化療

IntralesionalTriamcinolone內(nèi)部損傷用曲安西龍

1.0mg/cmtumordiameter腫瘤直徑1.0mg/cmtreatmentsat2weekintervals2周的治療周期definitivetherapy決定性治療priortosurgicalresection在手術(shù)治療前appropriateforsmalltumors適合小腫瘤CanineMCT-SurvivalData

犬肥大細(xì)胞瘤–存活期

RadiationTherapy;n=32dogs放射療法；Al-Sarraf(JVIM1996,inpress)Cobalt60;post-op;GradeII;54Gy

鈷60；術(shù)后；2級(jí)；54格雷1-yearsurvivalrate=100%1年存活率=100%2-5yearsurvivalrate=96%2-5年存活率=96%Softtissueascompriseapproximately15%ofallcanine“skin”andsubcutaneouscancers犬皮膚和皮下腫瘤幾近15%為軟組織肉瘤Annualincidenceisapproximately35/100,000每年的發(fā)病率達(dá)到35/100,000Arisefromavarietyofmesenchymaltissues由間質(zhì)組織異變引起Tumortypesinclude:腫瘤類型包括：as纖維肉瘤nervesheathtumors神經(jīng)鞘瘤hemangiopericytomas血管外皮細(xì)胞瘤malignantfibroushistiocytomas惡性纖維組織瘤as粘液肉瘤as脂肪肉瘤Commonfeaturesofsofttissueas:軟組織肉瘤的共同特征Theymayarisefromanyanatomicsiteinthebody可能起源于身體的任何解剖部位Theytendtoappearaspseudoencapsulatedfleshytumorsbuthavepoorlydefinedhistologicmargins它們表現(xiàn)為假包膜結(jié)締組織肉瘤，但是組織學(xué)分界不明顯Localrecurrenceafterconservativesurgicalexcisioniscommon保守手術(shù)切除術(shù)后常見局部復(fù)發(fā)Tendtometastasizethroughhematogenousmethodsinupto25%ofcases;regionallymphnodemetastasisisunusual(exceptforsynovialcella)超過25%的病例有通過血液轉(zhuǎn)移的趨勢(shì)；局部淋巴結(jié)轉(zhuǎn)移不常見（滑膜細(xì)胞肉瘤除外）Generallyhavepoorresponsetochemotherapyandradiationtherapyformeasurabledisease通常對(duì)化療和放療不敏感Mostreportsoftreatmenttodateinvolvetheuseofsurgeryorradiation迄今為止，大多數(shù)報(bào)道的治療方式為手術(shù)或放療Surgeryaloneforhemangiopericytoma對(duì)血管外皮細(xì)胞瘤只進(jìn)行手術(shù)治療Posternreporteda79%oneyearcontrolratePostern報(bào)道，一年控制率為79%Gravesreporteda31%recurrencerateforthesetumorsGraves報(bào)道，31%的復(fù)發(fā)率

Radiationalone單獨(dú)放療McChesney,etal,1989reporteda48-67%1yearcontrolrateanda33%2yearcontrolrateforcanineSTS

據(jù)McChesney,etal,1989報(bào)道，犬軟組織肉瘤1年控制率為48-67%，2年為33%RadiationandHyperthermia放療和高溫療法McChesney,Gillette,Dewhirst,1992mediantimetorecurrence=30months復(fù)發(fā)的平均時(shí)間為30個(gè)月1yearcontrolrate=approx.79%一年控制率接近79%ResultsMediansurvivalhasnotbeenreachedyet平均生存期仍未得出結(jié)論75%survivalat5years75%5年后仍存活Discussion/Conclusions討論/結(jié)論75%5yearsurvivalrate5年存活率75%Nocorrelationbetweensurvivalandtumortype,anatomiclocation,orgender存活去腫瘤類型，解剖位置和性別均無關(guān)Onlysignificantfactorswithrespecttosurvivalweredevelopmentofmetastaticdiseaseandtimetorecurrence關(guān)于存活的僅有重要因子為轉(zhuǎn)移性疾病和復(fù)發(fā)的時(shí)間a骨肉瘤Mostcommonprimarybonetumorinthedog犬最常見的原發(fā)性骨腫瘤Diseaseofmiddleagedtoolderdogs見于中年至老年犬Medianage7years平均年齡為7歲smallpeakinincidenceat18-24months在18-24月齡間有發(fā)病小高峰Canceroflargeandgiantbreeds大型和巨型犬的腫瘤appendicularmorecommoningiantbreeds巨型犬常見于四肢axialmorecommoninsmallerbreeds較小型犬常見于軀干OSA骨肉瘤Metaphysisoflongbones長骨干骺端frontlimbstwiceasoftenasrearlimbs前肢發(fā)病率為后肢2倍“Towardsthekneeandawayfromtheelbow”“向膝蓋和遠(yuǎn)離肘”Mayseesecondarytotrauma可繼發(fā)于外傷surgicalpins/plates外科骨針/骨板secondarytoRT繼發(fā)于放療OSA骨肉瘤

Metastasis轉(zhuǎn)移Lessthan5%havemetastasisatdiagnosis診斷時(shí)少于5%發(fā)生轉(zhuǎn)移90%+willdieofmetastasiswithin1yearifamputationistheonlytreatmentoffered如果截肢術(shù)是唯一的治療方式，超過90%的犬1年后將死于轉(zhuǎn)移Pulmonary,bonemostcommon最常見轉(zhuǎn)移位置為肺，骨。OSA骨肉瘤

Staging分期Chestradiographs胸部X光片Primaryradiographs原發(fā)影像bonescan?骨部影像Routinebloodtests常規(guī)血液檢查Surgicalbiopsy外科活組織檢查needlebiopsy細(xì)針活檢Incisional切開活檢Amputation截除術(shù)OSA骨肉瘤

Therapy治療a血管肉瘤Tumorarisingfromvascularendothelium腫瘤從血管的內(nèi)皮出現(xiàn)Tumorofolderdogs老齡犬的腫瘤8-13years8-13歲Majorityoccurinlargebreeds大多發(fā)生于大型犬German